Provider Demographics
NPI:1689762619
Name:HANNA, DAVID E (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:HANNA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 CALEVARES DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1301
Mailing Address - Country:US
Mailing Address - Phone:859-619-9615
Mailing Address - Fax:
Practice Address - Street 1:4360 CALEVARES DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1301
Practice Address - Country:US
Practice Address - Phone:859-619-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0604103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY30615058Medicaid
KY0045231Medicare ID - Type UnspecifiedMEDICARE
KY30615058Medicaid